POS0983 LIFESTYLE IN AXIAL SPONDYLOARTHRITIS - COMPARISONS BETWEEN PATIENTS AND CONTROLS, AXIAL SPONDYLOARTHRITIS SUBTYPES, MALE AND FEMALE PATIENTS, AND ITS ASSOCIATION WITH DISEASE AND HEALTH OUTCOMES. RESULTS FROM THE SPARTAKUS COHORT
Authors: E. Mogard, T. Olofsson, A. Bremander, J. Sagard, J. K. Wallman, E. Lindqvist
Journal: Annals of the Rheumatic Diseases (2022)

Background Healthy lifestyle behaviours are associated with better health outcomes and quality of life in the general population (1, 2). In patients with axial spondyloarthritis (axSpA), however, little is known regarding multiple lifestyle behaviours and their associations with disease and health outcomes. Objectives To study lifestyle behaviours in patients with axSpA in relation to healthy controls, between axSpA subtypes and male and female patients, respectively, and to assess how the presence of two or more unhealthy lifestyle factors associate with disease and health outcomes. Methods We performed a cross-sectional study of 250 well-characterized axSpA patients (167 with radiographic axSpA [r-axSpA; ASAS and/or modified New York criteria], 83 with non-radiographic axSpA [nr-axSpA; ASAS criteria]) and 48 controls (frequency-matched to the patients for age and sex), participating in the population-based SPARTAKUS study in southern Sweden. Self-reported data on smoking, alcohol use, physical activity, dietary habits, and objectively measured body mass index (BMI), respectively, for all subjects was categorized as fulfilling national recommendations or not (healthy/unhealthy), and summarized in an index (0-5, indicating the number of unhealthy lifestyle factors). The index was also dichotomized into 0-1 vs. 2-5 unhealthy lifestyle factors. Comparisons between patients and controls, axSpA subtypes (r-axSpA vs. nr-axSpA), and between male and female patients were performed by Student’s t-test/Chi-square test, as appropriate. Linear regression analyses were used to explore associations between having ≥2 unhealthy lifestyle factors (yes/no) and disease and health outcomes. Results Characteristics and lifestyle factors for axSpA patients and controls are presented in the Table 1. Reporting ≥2 unhealthy lifestyle factors was more common in axSpA patients than controls (35% vs. 19%, p=0.029), while no difference was found between the axSpA subtypes (Figure 1 a and b). Male patients more often reported several unhealthy lifestyle factors than female patients (Figure 1 c), with more frequent unhealthy alcohol use (19% vs. 9%, p=0.023) and overweight/obesity; BMI ≥25 (63% vs. 50%, p=0.043), while smoking, physical activity, and dietary habits were similar. In addition, older patients displayed more unhealthy lifestyle factors (Figure 1 d). Having ≥2 unhealthy lifestyle factors was associated with worse disease activity (ASDAS-CRP) (β-est [95% CI]) (0.34 [0.11: 0.58]), physical function (BASFI) (0.73 [0.18; 1.28]), pain (1.03 [0.39; 1.67]), fatigue (0.95 [0.24; 1.66]), and quality of life (EQ-5D) (-0.09 [-0.15; -0.02]) in axSpA patients, adjusted for age, sex, and axSpA subtype (all p≤0.010) Table 1. Characteristics and lifestyle factors r-axSpA/nr-axSpA combined n = 250 Controls n =48 Female sex 116 (46%) 24 (48%) Age, years 51 (13) 51 (14) Symptom duration, years 7.7 (7.6) N/A ASDAS-CRP 1.8 (0.9) N/A BASFI 2.0 (2.2) N/A BASMI 3.0 (1.6) N/A NRS patients’ global health 3.1 (2.5) 1.1 (1.1)* NRS pain 3.1 (2.5) 1.5 (1.6)* NRS fatigue 3.5 (2.8) 2.2 (2.0)* EQ-5D utility 0.72 (0.24) 0.90 (0.12)* Ongoing csDMARD 54 (22%) N/A Ongoing bDMARD 103 (41%) N/A Ongoing glucocorticoids 18 (7%) N/A Smoking, not fulfil rec. 31 (12%) 2 (4%) Alcohol, not fulfil rec. 35 (14%) 5 (10%) Physical activity, not fulfil rec. 72 (29%) 8 (17%) Dietary habits, not fulfil rec. 35 (14%) 5 (10%) BMI, not fulfil rec. 142 (57%) 15 (31%)* Mean (SD) or n (%). * p&lt;0.05 by Chi 2 -test or Student t-test, as appropriate. Missing data: ≤ 2%. Conclusion Unhealthy lifestyle behaviours were more common in axSpA patients than controls, and in male axSpA patients compared to females. Having two or more unhealthy lifestyle factors was associated with worse disease activity, physical function, pain, fatigue, and quality of life in the axSpA patients. References [1]Aleksandrova K, et al. BMC Medicine. 2014;12:168 [2]Lacombe J, et al. BMC Public Health. 2019;19:900 Disclosure of Interests Elisabeth Mogard Consultant of: Novartis, Tor Olofsson Consultant of: Eli Lilly, Merck Sharp &amp; Dohme, Ann Bremander: None declared, Jonas Sagard: None declared, Johan K Wallman Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Novartis, Grant/research support from: AbbVie, Amgen, Eli Lilly, Novartis, Pfizer, Elisabet Lindqvist: None declared